CAPNOGRAPHY In Emergency Care EDUCATIONAL SERIES Part 4: Non-intubated.

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CAPNOGRAPHY In Emergency Care EDUCATIONAL SERIES Part 4: Non-intubated

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Part 4: The Non-intubated Patient CAPNOGRAPHY In Emergency Care

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Part 4: The Non-intubated Patient Learning Objectives List three non-intubated applicationsList three non-intubated applications Identify four characteristic patterns seen inIdentify four characteristic patterns seen in –Bronchospasm AsthmaAsthma COPDCOPD –Hypoventilation states –Hyperventilation –Low-perfusion states

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The Non-intubated Patient Capnography Applications Capnography reflects changes inCapnography reflects changes in –Ventilation - movement of gases in and out of the lungs –Diffusion - exchange of gases between the air- filled alveoli and the pulmonary circulation –Perfusion - circulation of blood through the arterial and venous systems

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Capnography in Bronchospastic Conditions Prevalence of Asthma Asthma is increasing in the USAsthma is increasing in the US –20.3 million citizens report having asthma –Prevalence increased 75% from –Two million ED visits each year –Most common chronic health problem in children Increasing deaths due to asthmaIncreasing deaths due to asthma –1987 to 1995, death rate doubled to 5600 Sources: Delbridge T., et al Prehospital Asthma Management. Prehospital Emergency Care 7(1) Asthmatic Statistics. American Academy of Allergies, Asthma and Immunology. http.//www.aaaai.org

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Capnography in Bronchospastic Conditions Capnography in Asthma Research is underway on the correlation of capnographic changes to patient’s respiratory statusResearch is underway on the correlation of capnographic changes to patient’s respiratory status Anticipating clinical trials on the impact on patient care, outcomes and healthcare costsAnticipating clinical trials on the impact on patient care, outcomes and healthcare costs

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Capnography in Bronchospastic Conditions Asthma Case Scenario 16 year old female16 year old female C/O “having difficulty breathing”C/O “having difficulty breathing” Visible distressVisible distress History of asthma, physical exertion, “a cold”History of asthma, physical exertion, “a cold” Patient has used her “puffer” 8 times over the last two hoursPatient has used her “puffer” 8 times over the last two hours Pulse 126, BP 148/86, RR 34Pulse 126, BP 148/86, RR 34 Wheezing noted on expirationWheezing noted on expiration

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Capnography in Bronchospastic Conditions Prevalence of COPD COPD is increasing in the U.S.COPD is increasing in the U.S. –Fourth leading cause of death in adults –16 million cases in 1996 Increasing deaths due to COPDIncreasing deaths due to COPD –1999 estimated 110,000 –Number of deaths doubled in the past 25 years Source: Boyle, A.H Recommendations of the National Lung Health Education Program, Heart & Lung 29: 6:

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Capnography in Bronchospastic Conditions Assessment of COPD Symptoms and observations are primarily subjectiveSymptoms and observations are primarily subjective Severity of symptoms and your patient’s perception may not accurately reflect severity of conditionSeverity of symptoms and your patient’s perception may not accurately reflect severity of condition More objective data needed

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Capnography in Hypoventilation States Case Scenario Observer called 911Observer called year old male sleeping and unresponsive on sidewalk, “gash on his head”76 year old male sleeping and unresponsive on sidewalk, “gash on his head” Known history of hypertension, EtOH intoxicationKnown history of hypertension, EtOH intoxication Pulse 100, BP 188/82, RR 10, SpO 2 96% on room airPulse 100, BP 188/82, RR 10, SpO 2 96% on room air

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Capnography in Hypoventilation States Hypoventilation Time condensed; actual rate is slower

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Capnography in Hypoventilation States Hypoventilation Hypoventilation in shallow breathing